Endoskopska ultrasonografija u diferenciranju benignog od malignog ulkusa želuca
Sažetak
Uvod/Cilj. Ulkus želuca može biti benigna ili maligna bolest. Iz aspekta lečenja i prognoze bolesnika, rano otkrivanje maligniteta veoma je važno. Cilj studije bio je da se proceni uloga endoskopskog ultrazvuka (EUS) u diferenciranju benignih od malignih ulkusa želuca. Metod. Prospektivnom studijom bilo je obuhvaćeno 20 konsekutivnih odraslih bolesnika sa malignim ulkusom želuca i dvadeset konsekutivnih odraslih bolesnika sa benignim ulkusom želuca. Svim bolesnicima rađena je EUS. Analizirano je šest parametara: širina ulkusa, dubina ulkusa, zadebljanje zida želuca uz ivicu ulceracije (D0), zadebljanje zida želuca 2 cm od ivice ulceracije (D2), gubitak slojevne strukture zida želuca i prisustvo regionalnih limfnih čvorova. Formulisani su EUS kriterijumi maligniteta i poen-skor maligniteta. Takođe je proračunata kritična vrednost ukupnog poen-skora, koji je za procenu maligniteta imao najbolje parametre pouzdanosti. Rezultati. Postoje četiri kriterijuma maligniteta želudačne ulceracije: D0 > 10 mm; D2 > 5 mm, EUS vizualizacija bar jednog limfnog čvora i gubitak slojevne strukture zida želuca. Jedini nezavisni prediktor maligniteta ulceracije bila je vrednost D2 > 5 mm. Za ukupni poen-skor ≥ 4 dobijeni su najbolji parametri pouzdanosti za procenu maligniteta ulkusa: senzitivnost od 70%, specifičnost od 95%, pozitivna prediktivna stopa od 93,3%, negativna prediktivna stopa od 76% i tačnost od 82,5%. Zaključak. Prema rezultatima ove studije može se zaključiti da je metoda EUS korisna za diferenciranje benignih od malignih ulkusa želuca.
Reference
Del Valle J. Peptic ulcer disease and related disorders. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison′s Principles of internal medicine. 18th ed. New York, NY: McGraw-Hill; 2012. p. 2438−47.
Lv SX, Gan JH, Wang CC, Luo EP, Huang XP, Xie Y, et al. Bi-opsy from the base of gastric ulcer may find gastric cancer ear-lier. Med Hypotheses 2011; 76(2): 249−50.
Amorena Muro E, Borda Celaya F, Martínez-Peñuela Virseda JM, Borobio Aguilar E, Oquiñena Legaz S, Jiménez Pérez FJ. Analysis of the clinical benefits and cost-effectiveness of performing a systematic second-look gastroscopy in benign gastric ulcer. Gastroenterol Hepatol 2009; 32(1): 2−8. (Spanish)
Zhang W, Tong Q, Chen Z, Gao Y, Jin S, Wang Q, et al. The use-fulness of endoscopic ultrasound in the differential diagnosis between benign and malignant gastric ulcer. Scand J Gastroen-trol 2010; 45(9): 1093−6.
Yegin EG, Duman DG. Staging of esophageal and gastric cancer in 2014. Minerva Med 2014; 105(5): 391−411.
Cho JW. The role of endoscopic ultrasonography in T staging: early gastric cancer and esophageal cancer. Clin Endosc 2013; 46(3): 239−42.
Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultra-sonography (EUS) for the preoperative locoregional staging of primary gastric cancer. Cochrane Database Syst Rev 2015; 2: CD009944.
Kuran S, Ozin Y, Nessar G, Turhan N, Sasmaz N. Is endorectal ultrasound still useful for staging rectal cancer? Eur Rev Med Pharmacol Sci 2014; 18(19): 2857−62.
Akahoshi K, Oya M, Koga T, Koga H, Motomura Y, Kubokawa M, et al. Clinical usefulness of endoscopic ultrasound-guided fine needle aspiration for gastric subepithelial lesions smaller than 2 cm. J Gastrointestin Liver Dis 2014; 23(4): 405−12.
Giovannini M. The place of endoscopic ultrasound in bilio-pancreatic pathology. Gastroenterol Clin Biol 2010; 34(8−9): 436−45.
Keter D, Melzer E. Endoscopic ultrasound in clinical practice. Acta Gastroenterol Latinoam 2008; 38(2): 146−51.
Gavini H, Lee JH. Endoscopic ultrasound-guided endotherapy. J Clin Gastroenterol 2015; 49(3): 185−93.
Luz LP, Al-Haddad MA, DeWitt JA. EUS-guided celiac plexus interventions in pancreatic cancer pain: An update and controversies for the endosonographer. Endosc Ultrasound 2014; 3(4): 213−20.
Koçak E, Kılıç F, Akbal E, Taş A, Köklü S, Filik L, et al. The usefulness of ulcer size and location in the differential diagno-sis of benign and malignant gastric ulcer. Wien Klin Wochenschr 2013; 125(1−2): 21−5.
Lv SX, Gan JH, Ma XG, Wang CC, Chen HM, Luo EP, et al. Biopsy from the base and edge of gastric ulcer healing or complete healing may lead to detection of gastric cancer ear-lier: an 8 years endoscopic follow-up study. Hepatogastroenterology 2012; 59(115): 947−50.
Zhang J, Guo SB, Duan ZJ. Application of magnifying narrow-band imaging endoscopy for diagnosis of early gastric cancer and precancerous lesion. BMC Gastroenterol 2011; 11: 135.
Hirata I, Nakagawa Y, Ohkubo M, Yahagi N, Yao K. Usefulness of magnifying narrow-band imaging endoscopy for the diag-nosis of gastric and colorectal lesions. Digestion 2012; 85(2): 74−9.
Ratiu N, Rath HC, Büttner R, Gelbmann C, Klebl F, Kullmann F, et al. The effect of chromoendoscopy on the diagnostic improvement of gastric ulcers by endoscopists with different levels of experience. Rom J Gastroenterol 2005; 14(3): 239−44.
Moschetta M, Scardapane A, Telegrafo M, Lorusso V, Angelelli G, Stabile Ianora AA. Differential diagnosis between benign and malignant ulcers: 320-row CT virtual gastroscopy. Abdom Im-aging 2012; 37(6): 1066−73.
Chen CY, Kuo YT, Lee CH, Hsieh TJ, Jan CM, Jaw TS, et al. Differentiation between malignant and benign gastric ulcers: CT virtual gastroscopy versus optical gastroendoscopy. Radiology 2009; 252(2): 410−7.
Kimura K, Yoshida Y, Kihira K, Kasano T, Ido K. Endoscopic ul-trasonographic (EUS) evaluation of the quality of gastric ulcer healing. Gastroenterol Jpn 1993; 28(Suppl 5): 178−85.
Park YS, Lee D, Lee DH, Kim NY, Jeong SH, Kim JW, et al. Assessment of factors affecting the accuracy of endoscopic ultrasonography in T2 stage gastric cancer. Korean J Gastroentrol 2008; 52(2): 86−90. (Korean)
Okada K, Fujisaki J, Kasuga A, Omae M, Yoshimoto K, Hirasawa T, et al. Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection. Surg Endosc 2011; 25(3): 841−8.
Mouri R, Yoshida S, Tanaka S, Oka S, Yoshihara M, Chayama K. Usefulness of endoscopic ultrasonography in determining the depth of invasion and indication for endoscopic treatment of early gastric cancer. J Clin Gastroenterol 2009; 43(4): 318−22.
Akashi K, Yanai H, Nishikawa J, Satake M, Fukagawa Y, Okamo-to T, et al. Ulcerous change decreases the accuracy of endos-copic ultrasonography diagnosis for the inavasive depth of ear-ly gastric cancer. Int J Gastrointest Cancer 2006; 37(4):133−8.
Park JM, Ahn CW, Yi X, Hur H, Lee KM, Cho YK, et al. Efficacy of endoscopic ultrasonography for prediction of tumor depth in gastric cancer. J Gastric Cancer 2011; 11(2): 109−15.
Gill KR, Ghabril MS, Jamil LH, Hasan MK, McNeil RB, Wood-ward TA, et al. Endosonographic features predictive of malig-nancy in mediastinal lymph nodes in patients with lung cancer. Gastrointest Endosc 2010; 72(2): 265−71.
Gleeson FC, Clain JE, Papachristou GI, Rajan E, Topazian MD, Wang KK, et al. Prospective assessment of EUS criteria for lymphadenopathy associated with rectal cancer. Gastrointest Endosc 2009; 69(4): 896−903.
Peng HQ, Greenwald BD, Tavora FR, Kling E, Darwin P, Rodgers WH, et al. Evaluation of performance of EUS-FNA in preo-perative lymph node staging of cancers of esophagus, lung, and pancreas. Daign Cytopathol 2008; 36(5): 290−6.
Jamil LH, Kashani A, Scimeca D, Ghabril M, Gross SA, Gill KR, et all. Can endoscopic ultrasound distinguish between mediastinal benign lymph nodes and those involved by sarcoidosis, lymphoma, or metastasis? Dig Dis Sci 2014; 59(9): 2191−8.